October 2025
In this VETgirl online veterinary continuing education blog, Stefanie Perry, CVT, VTS (Dentistry) describes the value of considering dorsal recumbency patient positioning for comprehensive oral health assessment and treatment (COHAT) procedures in the dog. Dorsal recumbency allows for clear advantages for patient comfort and safety, as well as improved efficiency for the veterinary technician! Read below to learn how to optimize workflow using this ‘go-to’ positioning for your patient’s dental cleanings!

Dental Procedures: To Turn or Not to Turn?

Stefanie Perry, CVT, VTS (Dentistry)

Should dental procedures be performed in sternal, lateral, or dorsal recumbency? Every clinic has established routines that shape patient care, and change can feel daunting, especially when team members are hesitant to try new things. But evolving our methods is often the key to improving safety, efficiency, and patient outcomes.

Successful workflow changes are best introduced during team meetings or training, with clear explanations of the “how” and the “why.” When the entire staff understands the benefits to patients, veterinarians, and technicians, it will smooth the transition and avoid mistakes.

The Benefits of Dorsal Recumbency

Performing dentistry in dorsal recumbency offers clear advantages:

  • Neck extended, limiting irrigation from reaching the airway
  • Enhanced visualization of oral anatomy without repeated repositioning
  • Reduced risk of vagal stimulation, regurgitation, or other complications linked to frequent movement
  • Less strain on patients with orthopedic pain or arthritis
  • Fewer interruptions to vital sign monitoring and heat support (Fig 1)
  • Minimized manipulation of the endotracheal tube
  • Improved efficiency by eliminating time-consuming position changes

Photo courtesy of Stefanie Perry

When teams adopt dorsal recumbency, they often find that procedures run more smoothly and with fewer safety concerns. The change benefits both patients and the staff caring for them.

Among the available positions, dorsal recumbency offers significant advantages in three key areas: patient safety, workflow efficiency, and intraoral examination.

Patient Safety

Patient safety is the priority of veterinary medicine, and dentistry is no exception. While every practice has its own routines, safety protocols must be consistent and practical to uphold the standard of care.

Anesthesia itself carries inherent risks such as hypotension, arrhythmias, or other physiologic changes. Aspiration is an additional consideration in dental procedures. Ultrasonic scalers, high-speed drills, and irrigation fluids used to cool instruments can all contribute. Even with a properly placed endotracheal tube, aspiration is possible. Positioning is a critical factor in minimizing this risk.

Securing the Airway

Every anesthetized dental patient should have an appropriately sized, cuffed endotracheal tube. Inflate the cuff gradually until no leak is detected at 20 cmH₂O inspiratory pressure. This approach ensures an effective seal while reducing the chance of tracheal irritation or pressure necrosis. A secure airway is the final safeguard against aspiration.

Substances requiring airway protection in dentistry include:

  • Irrigation from power instruments
  • Blood
  • Mucus
  • Debris such as tartar or calculus

My approach: After induction and intubation, I begin with the patient in sternal recumbency to capture maxillary intraoral radiographs. I then rotate to dorsal recumbency, where most of the procedure takes place. As needed, I make small adjustments with partial head or chest rotations to access specific areas—without repositioning the entire patient. (Fig 2) 

Figure 2. Photo courtesy of Stefanie Perry

Other Positioning Points

Gauze or absorbent packs: Any material used to block irrigation from the throat must be changed regularly when soaked or when debris collects. These cause a hazard by trapping fluid when they’ve absorbed too much, and the material could be mistakenly left after recovery. Any material should be tied to the endotracheal tube as a double check that it is removed. Head and neck positioning can replace this with diligent attention to positioning.

Head and neck angle: The patient’s nose should be pointed toward the floor to keep irrigation flowing out of the mouth. Towels or other material to support the neck and help keep the nose down will make the neck more comfortable and prevent the position from accidentally changing. (Fig 3)

Figure 3. Photo courtesy of Stefanie Perry

Whole-Body Monitoring

Dental procedures may focus on the head, but prolonged positioning affects the entire body. A patient’s comfort and safety must be considered from nose to tail.

  • Head & Neck: Avoid overextension, cushion against hard or cold surfaces, and take care with patients who have cervical disc disease.
  • Eyes: Prevent contact with surfaces, lubricate at least every 30 minutes, and protect from debris or irrigation.
  • Thorax: Ensure patients with respiratory disease, obesity, or reduced lung function have room for chest wall expansion.
  • Spine: Limit twisting or torque in patients with intervertebral disc disease. Use bean bags or surgical positioners to support their body weight and prevent twisting.
  • Pelvis: Avoid full “frog-leg” positioning, which worsens hip arthritis and causes pain. Support on either side of the pelvis with positioners will prevent that. (Fig 4)
  • Stifles: Minimize tension, particularly in patients with osteoarthritis or a history of surgery. Avoid prolonged flexion of the knee if possible.

Figure 4. This patient has additional special needs as a forelimb amputee and additional positioning equipment prevents undue stress to his spinal column, shoulders, and pelvis. Photo courtesy of Stefanie Perry

Workflow Efficiency

If patient safety isn’t reason enough, consider efficiency. A comprehensive oral health assessment and treatment (COHAT) is time-intensive, and every minute counts. Each time a patient is rotated laterally, equipment must be adjusted, monitors repositioned, and anesthesia re-stabilized—all of which add up to lost time.

With dorsal recumbency, radiographs can still be performed by rotating only the head and neck. This not only spares patients unnecessary full-body movement but also allows staff to maintain consistency in monitoring and heat support. On busy days, those saved minutes per procedure quickly accumulate.

Workflow during a COHAT can make or break a schedule. By simplifying positioning, teams can reduce frustration, maintain anesthetic stability, and keep the day running on track.

Intraoral Exams Made Easier

Finally, dorsal recumbency makes intraoral exams more efficient. Nearly all oral surfaces including buccal, lingual, palatal, and caudal tissues are easily visualized in this position. This means more thorough evaluations with less repositioning and less risk of missing subtle pathology.

From a technician’s perspective, this efficiency is invaluable. It allows more time to focus on cleaning, scaling, and extractions rather than repositioning, while ensuring the veterinarian has the clearest possible view during the assessment.

Final Thoughts

Shifting to dorsal recumbency for dentistry may feel like a significant change, especially in practices accustomed to sternal or lateral positioning. But the benefits are hard to ignore. From improved patient safety to greater efficiency and more complete exams, this approach elevates the standard of care while reducing stress for the veterinary team.

The key to success lies in communication and training. When a team understands the reasoning behind a new approach and sees the benefits firsthand, implementation becomes far easier. By embracing thoughtful positioning strategies with the patient’s safety and comfort in mind, we not only safeguard our patients but also streamline our workflow and strengthen the bond within our teams.

Please note that the opinions in this blog are expressed by the author, and not directly endorsed by VETgirl.

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